Active NPI
Moshe Noam Green, D.M.D.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Decatur, GA
National Provider Identifier
1083055792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DN015014
- Practice address
- 2450 Lawrenceville Hwy
100
Decatur, GA 30033-3268 - Phone
- (404) 850-1515
- NPI assigned
- Jul 10, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DN015014 | GA | Primary |
Addresses
Primary practice location
2450 Lawrenceville Hwy
100
Decatur, GA 30033-3268
Mailing address
2450 Lawrenceville Hwy
100
Decatur, GA 30033-3268
Phone (404) 850-1515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161021000650 | GA | Order and Referring Only - Other (Physician) | 8820376197 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472169600000",
"number": "1083055792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 LAWRENCEVILLE HWY",
"address_2": "100",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333268",
"telephone_number": "404-850-1515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 LAWRENCEVILLE HWY",
"address_2": "100",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333268",
"telephone_number": "404-850-1515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MOSHE",
"middle_name": "NOAM",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-10",
"last_updated": "2016-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "GA",
"license": "DN015014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.